MEDICARE: DR. RAGAA R IBRAHIM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME77068	FL
2	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	ME77068	FL
3	207R00000X	Internal Medicine Physician	C52906	CA
4	208M00000X	Hospitalist Physician	C52906	CA

General Provider Information

NPI Number	:	1730128364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAGAA R IBRAHIM M.D.

Provider Business Mailing Address
First Line	:	3458 KARENA CT
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-3956
Country	:	US
Telephone Number	:	805-987-2679
Fax Number	:	805-987-2678

Provider Business Practice Location Address
First Line	:	3458 KARENA CT
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-3956
Country	:	US
Telephone Number	:	805-987-2679
Fax Number	:	805-987-2679

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	12/01/2021

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